Treating or looking at just office or hospital blood pressures can be very misleading. People often show artificially high blood pressures in these settings and can easily get over medicated if that is the only information your doctor or health provider has.

Rather than waiting for a medical evaluation or event to record your blood pressure, I would recommend investing in a good digital arm unit and record your morning blood pressure from time to time. Hypertension is not diagnosed with a single measurement, rather monitoring for trends and averages is how a doctor decides to treat elevated blood pressure. In general resting morning blood pressures should be under 140/90.

Earlier this week a patient of mine showed me another reformulation of Minocycline- this time for a mouth rinse for periodontal disease. It was going to cost her 240 dollars for one treatment and there was no data to share on effectiveness for the treatment. Her encounter reminded me of this piece I blogged in 2012. It is worth reviewing this information to keep the public informed. We all have choices to make.

This Friday’s Wall Street Journal (June 22,2012) features an article authored by Jonathan D. Rockoff reporting that Abbott Laboratories is contesting a portion of the healthcare law regarding patent protection. Patent protections for the drug industry have a long history. In a prior newsletter I explained to our readers/patients how name brand products and generics work. I would defer interested persons to that article if you wish to have more historical and practical information regarding this.

Abbott is challenging a portion of the healthcare bill that deals specifically with ‘biological medications’ (which by the way is the future for therapeutics). If their case wins, Abbott will guarantee future profit for their drug, Humira. Drug companies have a long history with patent law, and use it to maximize profits. Patent law, patient protection, and the price protecting properties of full dollar insurance work together to increase profits of pharmaceutical companies and…

The siege against the doctors continues. For decades some have been asking the government to report what they have been paying the individual doctors for Medicare services. Well, they finally did that and the Wall Street Journal was there to report it. What I find fascinating is that with all these decades to share such information with doctors (perhaps to allow us to peer review and reflect on what the data meant to us as providers) the government chose to dump it onto the public as some sort of “shame on the doctors” tactic. There was no real explanation or education about what this data means, just pages of payments based upon codes submitted for services rendered to Medicare patients by Medicare doctors.

“There is mention of unconscionably high costs. Costs imply price. It is imperative for the public to understand that the fees paid to physicians are set by the government via CMS. If there is a cost complaint, understand it isn’t the providers setting these fees. When you look at the data of the million plus paid group you will likely learn that these providers are charging for injectable and or infusion therapy. These fees are set by Medicare at a profit margin cap of 3-4% above the price the physician pays to the middleman (usually McKesson or Cardinal distributor companies). What this means is that the physician who billed Medicare for the product they bought passed through all but 3-4% of that fee. With that portion of paid services, 3-4% profit margin remains for the physician who then pays him/herself, staff, benefits, real estate expenses, his/her retirement benefits, etc. It is true that opthalmologist have the best “assembly line” model for care but that translates into high volume and therefore high service units being provided by a very limited number of doctors.

These high “costs” reflect high productivity. In all business models high productivity is what the market wants. A better reflection of whether a physician is “costing” medicare a lot of money is to look at patient visits. If a doctor has a lot of visits relative to his peers he or she may be getting more reimbursement but is more productive. Additionally visits have variable levels of complexity and often due to the pressure of coding requirements and fear of fraud accusations most providers actually undercharge/undercode the complexity of their care.

One needs to extract the pass-through revenues that go to the high cost of medication/injections/infusions. Then you have a better idea as to whether that physician is costly or just providing costly medication which is necessarily the price we are paying due to patent protection incentives to get really good therapy.

Folks are going to be barking up the wrong tree if they want to accuse the physicians for those costs- look instead towards the drug industry. Also bear in mind we the people and through our government policies set up these pricing mechanisms and patent incentives to get great medications and innovation. In most instances even though the prices are high, the drug industry costs are more than offset by improved worker productivity, less disability and the avoidance of even more expensive health care costs.”

To read more on issues related to Medicare and the perils of price-fixing in health care consider re-reading some of my prior blogs and a prior newsletter:

As I was winding down my office business today I realized I haven’t blogged for a bit of time. There have been plenty of things to blog about in the recent weeks but I have been “pulling back” as I contemplate the latest events.

Today I went back to my practice website and was reviewing the pricing section of my site. On that page I have an explanation of my philosophy about how I have come to stop contracting with health insurance companies and I feel it is worth posting today for general public consumption and contemplation. Here goes:

Why I’m not contracted with insurance companies

“because I work for you”

“I am passionate that the patient/physician relationship be maintained. This is the primary reason I have been on record repeatedly advocating for more patient choice and less health insurance and government interference with patient management. I serve the patient, not the insurance companies. In this day and age, the ability for the physician to maintain his or her position as the patient advocate is compromised by insurance, government or hospital-employer arrangements. I feel it is important to stay at an arm’s distance from a hospital employer, insurance payer paycheck and the government’s next pay cut if I am going to be able to properly take care of my patients. I don’t contract with private health insurance because over the years I have learned that the insurance companies don’t pass any savings to the patient. The companies also interfere with my care recommendations, from which prescription I can write to which test I can order. This interference paradoxically increases the cost of delivering care which explains a lot of the rising cost of health care in America and also compromises patients’ trust in the system and even in their doctor.”

In the recent February edition of Cardiology today a large data set (meta-analysis) that incorporated over 70,000 people supported the favorable risk-benefit profile for the new anticoagulants compared to warfarin. There were significant reductions in stroke, intracranial hemorrhage (often a life-threatening complication if it occurs) and mortality (that means benefit of total survival) compared to the old standard warfarin (Coumadin) in patients being treated for stroke reduction benefit in atrial fibrillation.

I had written a newsletter/blog on these new agents last year and then suggested these drugs would be game-changers in this common disease situation. This report supports that position. More and more patients are being transitioned to the newer agents; cost being the single major reason that patients and doctors don’t switch to these newer products. These drugs don’t have the drug and food interaction concerns that warfarin does. They also don’t require therapeutic monitoring as they work predictably when dose appropriately. Dropped kidney function does support the decision to use lower dose products and so monitoring of kidney function as well as blood counts still need to be performed but not at the same monthly interval that warfarin monitoring requires. These medications also are more user friendly for dosing before invasive surgeries- requiring much less time off medication (and thus less risk from being off therapy) prior to surgeries, colonoscopies, etc.

Bottom Line: The newer anticoagulants show favorable safety and effectiveness when compared to the former standard of care medication, warfarin for the indication of reducing stroke risk in atrial fibrillation, a heart rhythm condition commonly associated with cardio-embolic strokes. The newer agents currently FDA approved in the United States include: Pradaxa, Xarelto and Eliquis, all name brand, patent- protected pill medications.